Uso de ácidos grasos hiperoxigenados para la protección cutánea durante la pandemia de COVID-19 en España: encuesta a profesionales / Use of hyperoxygenated fatty acids for skin protection during the COVID-19 pandemic in Spain: survey of professionals

Durante la pandemia de COVID-19, un elevado número de profesionales ha estado a riesgo de desarrollar lesiones en la piel, secundarias al uso de equipos de protección individual. Diversas guías de práctica recomiendan el uso de AGHO para reducir la aparición de úlceras por presión; se presentan los resultados de una encuesta realizada en el ámbito nacional a la que respondieron un total de 134 profesionales sobre el uso de AGHO para su prevención. El momento de la aplicación del ácido graso fue, en el 58,2 %, después de la retirada del EPI; en el 25,4 %, diez minutos antes de la colocación de los equipos de protección; en el 7,5 %, en el momento de la colocación de los equipos de protección; en el 6,7 %, entre 10-30 minutos antes de la colocación de los equipos de protección, y en el 2,2 %, treinta minutos antes de la aplicación de los equipos de protección. Los profesionales que respondieron refieren, en el 73,1 % de los casos, una mejora del eritema pre-existente; para el 56,7 %, proporciona hidratación de la piel; en el 50 % de los casos contribuye a la prevención de las lesiones cutáneas relacionadas con el uso de los sistemas de protección individuales; en el 26,1 %, aporta un efecto emoliente sobre la piel. A partir de los resultados se recomienda el uso de estas substancias tópicas (AGHO) en caso de uso de equipos de protección individual

During the Covid-19 pandemic, a high number of professionals have been at risk of developing skin lesions secondary to the use of personal protective equipment. The clinical practice guidelines recommend the use of fatty acids to reduce the appearance of pressure ulcers. Here are described the results of a survey conducted at the national level, that included a total of 134 professionals. The moment of the application of the fatty acid was, 58.2%, after the removal of the individual equipment protection; in 25.4%, ten minutes before the placement of the protective equipment; in 7.5%, at the time of the donning of the protective equipment; in 6.7%, between 10-30 minutes before putting on the protective equipment, and in 2.2%, thirty minutes before the application of the protective equipment. The professionals who responded referred, in 73.1% of the cases, an improvement of the pre-existing erythema; in 56.7%, this substance provides hydration of the skin; in 50% of the cases, it contributes to the prevention of related skin lesions with the use of individual protection systems; in 26.1%, it provides an emollient effect on the skin. Based on the results, the use of these topical substances (fatty acids) is recommended in the case of the use of personal protective equipment

Incidencia de la infección nosocomial en pacientes trasplantados hepáticos. Factores de riesgo y rol de las enfermeras / Incidence of cross infection in liver transplant patients. Risk factors and role of nursinge

Objetivo: Conocer la incidencia de infección en pacientes trasplantados hepáticos, en el postrasplante inmediato y los factores de riesgo de infección, durante el ingreso en una unidad de trasplante hepático. Metodología: Estudio descriptivo, prospectivo realizado en la Unidad de trasplante hepático del Hospital Clínic que incluyó a todos los pacientes que fueron trasplantados entre enero de 2012 y agosto de 2015(n=241). Se realizó el análisis de datos con el paquete estadístico R Comander. Las variables cualitativas se compararon con el chi2 y las cuantitativas con la t de Student, considerándose significativa una p≤ 0,05. Resultados: La incidencia de infección fue de 34,8% (n=241). Las bacterianas fueron las más frecuentes (75,3%) y dentro de estas las urinarias (34%) causadas por Escherichia coli y Klebsiella pneumoniae. Realizado el análisis multivariado en las infecciones bacterianas, se observó que el sexo, la edad y los días de estancia en hospital fueron los factores predictivos independientes. Conclusiones: La infección bacteriana en el postrasplante inmediato es común y repercute en la recuperación del paciente, implicando más días de estancia hospitalaria y más procesos invasivos. El personal de enfermería debe conocer los factores de riesgo relacionados con la infección para extremar medidas de prevención. La correcta aplicación de las recomendaciones publicadas en la bibliografía sobre la inserción, mantenimiento y retirada precoz de dispositivos médicos y el cumplimiento de la higiene de manos son fundamentales (AU)

Objective: To determine the incidence and risk factors of infection in liver transplant recipients immediately post-transplant, during admission to a liver transplant unit during the immediate post-transplant admission. Methodology: Descriptive, prospective study performed in the Liver Transplant Unit of Hospital Clínic, Barcelona. All liver transplant recipients between January 2012 and August 2015 (n=241) were included. Statistical analysis was performed with R Commander. Variables were compared with Chi-square and Student's t-test. A value of p≤.05 was considered significant. Results: The incidence of infection was 34.8%. The most frequent infections were bacterial (75.3%), particularly urinary infections (34.6%) caused by Escherichia coli and Klebsiella pneumoniae. Independent risk factors for the development of bacterial infections according to multivariate analysis were sex, age and length of hospital stay. Conclusions: Infections are a significant problem in the early post-transplant period, and are associated with longer hospitalisation periods. The role of nursing in preventing infections, by identifying risk factors, correctly applying nursing protocols in insertion, maintenance and early withdrawal of medical devices and fulfilling hand hygiene, is essential (AU)

Incidence of cross infection in liver transplant patients. Risk factors and role of nursinge. / Incidencia de la infección nosocomial en pacientes trasplantados hepáticos. Factores de riesgo y rol de las enfermeras.

OBJECTIVE: To determine the incidence and risk factors of infection in liver transplant recipients immediately post-transplant, during admission to a liver transplant unit during the immediate post-transplant admission. METHODOLOGY: Descriptive, prospective study performed in the Liver Transplant Unit of Hospital Clínic, Barcelona. All liver transplant recipients between January 2012 and August 2015 (n=241) were included. Statistical analysis was performed with R Commander. Variables were compared with Chi-square and Student's t-test. A value of p≤.05 was considered significant. RESULTS: The incidence of infection was 34.8%. The most frequent infections were bacterial (75.3%), particularly urinary infections (34.6%) caused by Escherichia coli and Klebsiella pneumoniae. Independent risk factors for the development of bacterial infections according to multivariate analysis were sex, age and length of hospital stay. CONCLUSIONS: Infections are a significant problem in the early post-transplant period, and are associated with longer hospitalisation periods. The role of nursing in preventing infections, by identifying risk factors, correctly applying nursing protocols in insertion, maintenance and early withdrawal of medical devices and fulfilling hand hygiene, is essential.

Análisis prospectivo de la colonización de catéteres centrales y sus factores relacionados / Prospective analysis of central venous catheter colonization and related factors

Objetivo. Conocer la incidencia de colonización de los catéteres venosos centrales (CVC) en las unidades de hospitalización del Institut de Malalties Digestives i Metaboliques (IMDiM) del Hospital Clínic de Barcelona con intención de reducir el riesgo de infección. Método. Estudio descriptivo, prospectivo y longitudinal, de 4 meses de duración. Fueron objeto de estudio los pacientes ingresados en las unidades del IMDiM, portadores de CVC (n = 230). Al retirar el catéter, se procedía al cultivo de la punta del mismo, realizándose 2 hemocultivos si el paciente presentaba fiebre. Se creó una base de datos. Se analizó con SPSS versión 11.0. Las variables se compararon mediante prueba de χ2, test de la t de Student y se realizó un análisis multivariante mediante la regresión logística de Cox, considerándose significativa una p igual o inferior a 0,05. Resultados. El cultivo de punta de catéter fue positivo en el 45,2%, con una tasa de bacteriemia relacionada con catéter, clínicamente significativa de 2,9 ‰ días de catéter. La probabilidad de contaminación de punta de catéter fue del 25% a los 10 días de colocación. Realizado el análisis multivariado, observamos que el tipo de catéter, el cambio de apósito y la infección bacteriana de las llaves, fueron las 3 variables independientes asociadas a un mayor riesgo de infección. Conclusiones. Estos resultados sugieren que: 1) se debería revisar y actualizar el protocolo de inserción y mantenimiento de catéteres; 2) valorar la permanencia de éstos a partir del 10.º día, y 3) seleccionar adecuadamente el tipo de catéter que se va a colocar, utilizar el de menor número de luces necesario, así como disminuir el número de cambios de apósito(AU)

Objective: To evaluate the incidence of central venous catheter (CVC) colonization in inpatient units of the Institut de Malalties Digestives i Metabòliques (IMDiM) of Hospital Clinic (Barcelona, Spain) with a view to reducing the risk of infection. Method: A 4-month descriptive, prospective and longitudinal study was performed. A total of 230 patients admitted to the IMDiM with CVC were included during the study period. At catheter removal, the tip was cultured and, if the patient had fever, two blood cultures were also obtained. A data base was created. Data were analyzed using SPSS v.11.0. Variables were compared with the Chi-square and Student’s t-tests and a multivariate analys is was performed using Cox logistic regression. Avalue of P<0.05was considered significant. Results: Catheter tip culture was positive in 45.2%. The rate of catheter-related blood stream infections was 2.9 % catheter-days, which was clinically significant. The probability of catheter tip contamination 10 days after placement was 25%. Multivariateanalysis revealed that the independent variables associated with a higher risk of infection were catheter type, changes of dressing, and infected bacterial stopcocks. Conclusions: These results suggestthat: 1) the protocol for catheter insertion and care should be reviewed and up dated, 2 catheter removal should be considered after the 10th day, 3) the appropriate type of catheter should be selected, the catheter with the lowest number of lumens should be used, and changes of catheter dressing should be reduced(AU)

[Prospective analysis of central venous catheter colonization and related factors]. / Análisis prospectivo de la colonización de catéteres centrales y sus factores relacionados.

OBJECTIVE: To evaluate the incidence of central venous catheter (CVC) colonization in inpatient units of the Institut de Malalties Digestives i Metabòliques (IMDiM) of Hospital Clinic (Barcelona, Spain) with a view to reducing the risk of infection. METHOD: A 4-month descriptive, prospective and longitudinal study was performed. A total of 230 patients admitted to the IMDiM with CVC were included during the study period. At catheter removal, the tip was cultured and, if the patient had fever, two blood cultures were also obtained. A database was created. Data were analyzed using SPSS v.11.0. Variables were compared with the Chi-square and Student's t-tests and a multivariate analysis was performed using Cox logistic regression. A value of P<0.05 was considered significant. RESULTS: Catheter tip culture was positive in 45.2%. The rate of catheter-related bloodstream infections was 2.9 per thousand catheter-days, which was clinically significant. The probability of catheter tip contamination 10 days after placement was 25%. Multivariate analysis revealed that the independent variables associated with a higher risk of infection were catheter type, changes of dressing, and infected bacterial stopcocks. CONCLUSIONS: These results suggest that: 1) the protocol for catheter insertion and care should be reviewed and updated, 2) catheter removal should be considered after the 10th day, 3) the appropriate type of catheter should be selected, the catheter with the lowest number of lumens should be used, and changes of catheter dressing should be reduced.